State of Illinois
91st General Assembly
Legislation

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[ Engrossed ][ Enrolled ][ Senate Amendment 001 ]

91_SB1613

 
                                               LRB9112970JSpc

 1        AN   ACT  concerning  the  care  of  Alzheimer's  disease
 2    patients.

 3        Be it enacted by the People of  the  State  of  Illinois,
 4    represented in the General Assembly:

 5        Section  5.   The Alternative Health Care Delivery Act is
 6    amended by changing Sections 30 and 35 as follows:

 7        (210 ILCS 3/30)
 8        Sec.  30.   Demonstration  program   requirements.    The
 9    requirements  set  forth  in  this  Section  shall  apply  to
10    demonstration programs.
11        (a)  There shall be no more than:
12             (i)  3  subacute  care  hospital  alternative health
13        care models in the City of Chicago (one of which shall be
14        located on a designated site and shall have been licensed
15        as a hospital under the Illinois Hospital  Licensing  Act
16        within  the  10  years immediately before the application
17        for a license);
18             (ii)  2 subacute care  hospital  alternative  health
19        care  models in the demonstration program for each of the
20        following areas:
21                  (1)  Cook County outside the City of Chicago.
22                  (2)  DuPage,  Kane,  Lake,  McHenry,  and  Will
23             Counties.
24                  (3)  Municipalities with a  population  greater
25             than  50,000  not  located in the areas described in
26             item (i) of subsection (a) and  paragraphs  (1)  and
27             (2) of item (ii) of subsection (a); and
28             (iii)  4  subacute  care hospital alternative health
29        care models in the demonstration program for rural areas.
30        In selecting among applicants for these licenses in rural
31    areas,  the  Health  Facilities  Planning   Board   and   the
 
                            -2-                LRB9112970JSpc
 1    Department  shall  give  preference  to hospitals that may be
 2    unable for economic reasons to provide continued  service  to
 3    the  community  in which they are located unless the hospital
 4    were to receive an alternative health care model license.
 5        (a-5)  There  shall  be  no  more  than  a  total  of  12
 6    postsurgical recovery care  center  alternative  health  care
 7    models in the demonstration program, located as follows:
 8             (1)  Two in the City of Chicago.
 9             (2)  Two in Cook County outside the City of Chicago.
10        At  least  one  of  these shall be owned or operated by a
11        hospital devoted exclusively to caring for children.
12             (3)  Two in Kane, Lake, and McHenry Counties.
13             (4)  Four in municipalities  with  a  population  of
14        50,000  or  more  not  located  in the areas described in
15        paragraphs (1), (2), and (3), 3 of which shall  be  owned
16        or  operated  by  hospitals, at least 2 of which shall be
17        located in  counties  with  a  population  of  less  than
18        175,000,  according  to  the most recent decennial census
19        for which data are available, and one of which  shall  be
20        owned  or  operated  by  an ambulatory surgical treatment
21        center.
22             (5)  Two in rural areas,  both  of  which  shall  be
23        owned or operated by hospitals.
24        There  shall  be  no  postsurgical  recovery  care center
25    alternative health  care  models  located  in  counties  with
26    populations  greater than 600,000 but less than 1,000,000.  A
27    proposed postsurgical recovery care center must be  owned  or
28    operated by a hospital if it is to be located within, or will
29    primarily  serve  the  residents of, a health service area in
30    which more than 60% of  the  gross  patient  revenue  of  the
31    hospitals  within  that  health service area are derived from
32    Medicaid  and  Medicare,  according  to  the  most   recently
33    available  calendar  year  data from the Illinois Health Care
34    Cost Containment Council.  Nothing in  this  paragraph  shall
 
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 1    preclude  a  hospital  and  an  ambulatory surgical treatment
 2    center  from  forming  a  joint  venture  or   developing   a
 3    collaborative  agreement  to  own  or  operate a postsurgical
 4    recovery care center.
 5        (a-10)  There  shall  be  no  more  than  a  total  of  8
 6    children's respite care center alternative health care models
 7    in the demonstration  program,  which  shall  be  located  as
 8    follows:
 9             (1)  One in the City of Chicago.
10             (2)  One in Cook County outside the City of Chicago.
11             (3)  A  total  of 2 in the area comprised of DuPage,
12        Kane, Lake, McHenry, and Will counties.
13             (4)  A  total  of  2  in   municipalities   with   a
14        population  of  50,000  or  more  and  not located in the
15        areas described in paragraphs (1), (2), or (3).
16             (5)  A total of 2 in rural areas, as defined by  the
17        Health Facilities Planning Board.
18        No  more than one children's respite care model owned and
19    operated by a licensed skilled pediatric  facility  shall  be
20    located  in  each  of the areas designated in this subsection
21    (a-10).
22        (a-15)  There  shall  be  an  authorized  community-based
23    residential rehabilitation  center  alternative  health  care
24    model  in  the  demonstration  program.   The community-based
25    residential rehabilitation center shall  be  located  in  the
26    area of Illinois south of Interstate Highway 70.
27        (a-20)  There  shall be an authorized Alzheimer's disease
28    management  center  alternative  health  care  model  in  the
29    demonstration program.  The  Alzheimer's  disease  management
30    center shall be located in Will County.
31        (b)  Alternative  health  care models, other than a model
32    authorized  under   subsection   (a-20),   shall   obtain   a
33    certificate  of  need  from  the  Illinois  Health Facilities
34    Planning Board under the Illinois Health Facilities  Planning
 
                            -4-                LRB9112970JSpc
 1    Act  before  receiving a license by the Department. If, after
 2    obtaining its initial certificate  of  need,  an  alternative
 3    health   care  delivery  model  that  is  a  community  based
 4    residential rehabilitation center seeks to increase  the  bed
 5    capacity of that center, it must obtain a certificate of need
 6    from  the  Illinois  Health  Facilities Planning Board before
 7    increasing the bed capacity.  Alternative  health care models
 8    in medically underserved  areas  shall  receive  priority  in
 9    obtaining a certificate of need.
10        (c)  An  alternative  health  care model license shall be
11    issued for a period of one year and shall be annually renewed
12    if the facility or program is in substantial compliance  with
13    the  Department's  rules  adopted  under this Act. A licensed
14    alternative  health  care  model  that  continues  to  be  in
15    substantial  compliance   after   the   conclusion   of   the
16    demonstration  program  shall be eligible for annual renewals
17    unless and until a different licensure program for that  type
18    of  health  care  model  is  established  by legislation. The
19    Department may issue a provisional license to any alternative
20    health care model that does not substantially comply with the
21    provisions of this Act and the rules adopted under  this  Act
22    if  (i) the Department finds that the alternative health care
23    model has  undertaken  changes  and  corrections  which  upon
24    completion  will  render the alternative health care model in
25    substantial compliance with this Act and rules and  (ii)  the
26    health  and  safety of the patients of the alternative health
27    care model will be protected during the period for which  the
28    provisional  license  is issued.  The Department shall advise
29    the licensee of the conditions under  which  the  provisional
30    license   is  issued,  including  the  manner  in  which  the
31    alternative health  care  model  fails  to  comply  with  the
32    provisions  of  this Act and rules, and the time within which
33    the changes and corrections  necessary  for  the  alternative
34    health  care  model to substantially comply with this Act and
 
                            -5-                LRB9112970JSpc
 1    rules shall be completed.
 2        (d)  Alternative   health   care   models   shall    seek
 3    certification  under  Titles  XVIII  and  XIX  of the federal
 4    Social Security Act.  In addition,  alternative  health  care
 5    models  shall  provide  charitable  care consistent with that
 6    provided  by  comparable  health  care   providers   in   the
 7    geographic area.
 8        (d-5)  The   Illinois   Department   of  Public  Aid,  in
 9    cooperation with the Illinois Department  of  Public  Health,
10    shall  develop  and implement a reimbursement methodology for
11    all facilities participating in  the  demonstration  program.
12    The  Illinois Department of Public Aid shall keep a record of
13    services  provided  under  the   demonstration   program   to
14    recipients  of  medical  assistance under the Illinois Public
15    Aid  Code  and  shall  submit  an  annual  report   of   that
16    information to the Illinois Department of Public Health.
17        (e)  Alternative  health care models shall, to the extent
18    possible, link  and  integrate  their  services  with  nearby
19    health care facilities.
20        (f)  Each alternative health care model shall implement a
21    quality  assurance  program  with  measurable benefits and at
22    reasonable cost.
23    (Source: P.A. 91-65, eff. 7-9-99.)

24        (210 ILCS 3/35)
25        Sec. 35.   Alternative  health  care  models  authorized.
26    Notwithstanding  any  other  law to the contrary, alternative
27    health  care  models  described  in  this  Section   may   be
28    established on a demonstration basis.
29             (1)  Alternative  health  care  model; subacute care
30        hospital.  A subacute care hospital is a designated  site
31        which  provides  medical  specialty care for patients who
32        need a greater  intensity  or  complexity  of  care  than
33        generally  provided in a skilled nursing facility but who
 
                            -6-                LRB9112970JSpc
 1        no longer require acute hospital care. The average length
 2        of stay for patients treated in subacute  care  hospitals
 3        shall  not  be  less  than  20  days,  and for individual
 4        patients, the expected length of  stay  at  the  time  of
 5        admission  shall  not  be  less than 10 days.  Variations
 6        from minimum lengths of stay shall  be  reported  to  the
 7        Department.  There shall be no more than 13 subacute care
 8        hospitals   authorized  to  operate  by  the  Department.
 9        Subacute care includes physician supervision,  registered
10        nursing,  and  physiological  monitoring  on  a continual
11        basis. A subacute care hospital is either a  freestanding
12        building  or  a  distinct physical and operational entity
13        within a hospital or nursing home building.   A  subacute
14        care  hospital  shall  only  consist  of  beds  currently
15        existing   in   licensed  hospitals  or  skilled  nursing
16        facilities,  except,  in  the  City  of  Chicago,  on   a
17        designated site that was licensed as a hospital under the
18        Illinois  Hospital  Licensing  Act  within  the  10 years
19        immediately before the  application  for  an  alternative
20        health care model license. During the period of operation
21        of  the demonstration project, the existing licensed beds
22        shall remain licensed  as  hospital  or  skilled  nursing
23        facility  beds  as well as being licensed under this Act.
24        In order to handle cases of  complications,  emergencies,
25        or  exigent circumstances, a subacute care hospital shall
26        maintain a contractual relationship, including a transfer
27        agreement, with a general  acute  care  hospital.   If  a
28        subacute  care  model  is located in a general acute care
29        hospital, it shall utilize all or a portion  of  the  bed
30        capacity  of that existing hospital.  In no event shall a
31        subacute care hospital use the  word  "hospital"  in  its
32        advertising  or marketing activities or represent or hold
33        itself  out  to  the  public  as  a  general  acute  care
34        hospital.
 
                            -7-                LRB9112970JSpc
 1             (2)  Alternative   health   care   delivery   model;
 2        postsurgical  recovery  care  center.    A   postsurgical
 3        recovery  care center is a designated site which provides
 4        postsurgical recovery care for generally healthy patients
 5        undergoing surgical  procedures  that  require  overnight
 6        nursing  care,  pain  control,  or observation that would
 7        otherwise  be  provided  in  an  inpatient  setting.    A
 8        postsurgical  recovery care center is either freestanding
 9        or a defined unit of  an  ambulatory  surgical  treatment
10        center   or  hospital.  No  facility,  or  portion  of  a
11        facility, may participate in a demonstration program as a
12        postsurgical recovery care center unless the facility has
13        been licensed as an ambulatory surgical treatment  center
14        or  hospital  for at least 2 years before August 20, 1993
15        (the effective date of Public Act 88-441).   The  maximum
16        length  of  stay  for patients in a postsurgical recovery
17        care center is not to exceed 48 hours unless the treating
18        physician requests an extension of time from the recovery
19        center's medical director on  the  basis  of  medical  or
20        clinical  documentation that an additional care period is
21        required for the recovery of a patient  and  the  medical
22        director  approves  the  extension  of time.  In no case,
23        however,  shall  a  patient's  length  of   stay   in   a
24        postsurgical  recovery  care  center  be  longer  than 72
25        hours. If a patient requires an  additional  care  period
26        after  the  expiration  of the 72-hour limit, the patient
27        shall be transferred to an appropriate facility.  Reports
28        on variances from the 48-hour limit shall be sent to  the
29        Department for its evaluation.  The reports shall, before
30        submission  to the Department, have removed from them all
31        patient and physician identifiers.  In  order  to  handle
32        cases   of   complications,   emergencies,   or   exigent
33        circumstances, every postsurgical recovery care center as
34        defined  in  this  paragraph shall maintain a contractual
 
                            -8-                LRB9112970JSpc
 1        relationship, including  a  transfer  agreement,  with  a
 2        general  acute  care  hospital.   A postsurgical recovery
 3        care  center  shall  be  no  larger  than  20   beds.   A
 4        postsurgical recovery care center shall be located within
 5        15  minutes  travel  time  from  the  general  acute care
 6        hospital with which the center  maintains  a  contractual
 7        relationship, including a transfer agreement, as required
 8        under this paragraph.
 9             No   postsurgical   recovery   care   center   shall
10        discriminate  against  any  patient  requiring  treatment
11        because  of the source of payment for services, including
12        Medicare and Medicaid recipients.
13             The Department shall adopt rules  to  implement  the
14        provisions  of  Public Act 88-441 concerning postsurgical
15        recovery care centers within 9 months  after  August  20,
16        1993.
17             (3)  Alternative   health   care   delivery   model;
18        children's  respite  care  center.   A children's respite
19        care center model is  a  designated  site  that  provides
20        respite  for  medically frail, technologically dependent,
21        clinically stable children, up to age 18, for a period of
22        one to 14 days.   This  care  is  to  be  provided  in  a
23        home-like   environment  that  serves  no  more  than  10
24        children  at  a  time.  Children's  respite  care  center
25        services must be available  through  the   model  to  all
26        families,  including those whose care is paid for through
27        the Illinois Department of Public  Aid  or  the  Illinois
28        Department of Children and Family Services.  Each respite
29        care  model  location  shall  be  a  facility  physically
30        separate  and  apart  from any other facility licensed by
31        the Department of Public Health under this or  any  other
32        Act  and  shall  provide,  at  a  minimum,  the following
33        services: out-of-home  respite  care;  hospital  to  home
34        training   for   families   and  caregivers;  short  term
 
                            -9-                LRB9112970JSpc
 1        transitional care to facilitate  placement  and  training
 2        for  foster  care  parents;  parent  and  family  support
 3        groups.
 4             Coverage  for  the services provided by the Illinois
 5        Department of Public Aid  under  this  paragraph  (3)  is
 6        contingent  upon  federal waiver approval and is provided
 7        only to Medicaid eligible clients  participating  in  the
 8        home  and  community  based services waiver designated in
 9        Section 1915(c) of the Social Security Act for  medically
10        frail and technologically dependent children.
11             (4)  Alternative   health   care   delivery   model;
12        community  based  residential  rehabilitation  center.  A
13        community-based residential rehabilitation  center  model
14        is  a  designated  site  that  provides rehabilitation or
15        support, or both, for persons who have experienced severe
16        brain injury, who are medically stable, and who no longer
17        require acute rehabilitative care or intense  medical  or
18        nursing  services.   The  average  length  of  stay  in a
19        community-based residential rehabilitation  center  shall
20        not exceed 4 months.  As an integral part of the services
21        provided,  individuals  are housed in a supervised living
22        setting while having immediate access to  the  community.
23        The  residential  rehabilitation center authorized by the
24        Department may have  more  than  one  residence  included
25        under  the license.  A residence may be no larger than 12
26        beds and shall be located as  an  integral  part  of  the
27        community.   Day  treatment  or individualized outpatient
28        services shall be provided  for  persons  who  reside  in
29        their  own  home.   Functional  outcome  goals  shall  be
30        established for each individual.  Services shall include,
31        but  are  not  limited  to, case management, training and
32        assistance  with  activities  of  daily  living,  nursing
33        consultation,    traditional     therapies     (physical,
34        occupational,  speech),  functional  interventions in the
 
                            -10-               LRB9112970JSpc
 1        residence  and  community   (job   placement,   shopping,
 2        banking,    recreation),    counseling,   self-management
 3        strategies,   productive   activities,    and    multiple
 4        opportunities   for   skill   acquisition   and  practice
 5        throughout the day.  The design of individualized program
 6        plans shall be consistent with the outcome goals that are
 7        established for each resident.  The programs provided  in
 8        this  setting  shall  be  accredited by the Commission on
 9        Accreditation of Rehabilitation Facilities  (CARF).   The
10        program  shall  have  been  accredited by CARF as a Brain
11        Injury  Community-Integrative  Program  for  at  least  3
12        years.
13             (5)  Alternative   health   care   delivery   model;
14        Alzheimer's disease management  center.   An  Alzheimer's
15        disease management center model is a designated site that
16        provides  a  safe  and secure setting for care of persons
17        diagnosed  with  Alzheimer's  disease.   An   Alzheimer's
18        disease  management  center  model  shall  be  a facility
19        separate  from  any  other  facility  licensed   by   the
20        Department  of Public Health under this or any other Act.
21        An Alzheimer's disease management  center  shall  conduct
22        and  document  an  assessment  of  each  resident every 6
23        months.  The assessment shall include  an  evaluation  of
24        daily   functioning,   cognitive  status,  other  medical
25        conditions,  and  behavioral  problems.   An  Alzheimer's
26        disease management center shall develop and implement  an
27        ongoing  treatment plan for each resident.  The treatment
28        plan shall have defined goals  and  include  the  use  of
29        cholinesterase  inhibitors,  if  clinically indicated, to
30        treat  cognitive   decline,   referral   to   appropriate
31        structured  activities  such as exercise, recreation, and
32        adult day care services, and  appropriate  medical  care.
33        The  Alzheimer's  disease  management  center shall treat
34        behavioral   problems   and    mood    disorders    using
 
                            -11-               LRB9112970JSpc
 1        nonpharmacologic   approaches   such   as   environmental
 2        modification,  task simplification, and other appropriate
 3        activities.  An  Alzheimer's  disease  management  center
 4        shall  provide  education  and  support for residents and
 5        caregivers.  The  education  and  support  shall  include
 6        referrals   to   support  organizations  for  educational
 7        materials on community resources, support  groups,  legal
 8        and financial issues, respite care, and future care needs
 9        and  options.   The  education  and  support  shall  also
10        include  a  discussion  of  the  resident's  need to make
11        advance directives and to identify surrogates for medical
12        and  legal  decision-making.   The  provisions  of   this
13        paragraph  establish  the  minimum level of services that
14        must be provided by  an  Alzheimer's  disease  management
15        center.
16    (Source: P.A. 91-65, eff. 7-9-99; 91-357, eff. 7-29-99.)

17        Section  10.  The Alzheimer's Special Care Disclosure Act
18    is amended by changing Section 10 as follows:

19        (210 ILCS 4/10)
20        (Text of Section before amendment by P.A. 91-656)
21        Sec.  10.   Facility  defined.   As  used  in  this  Act,
22    "facility" means a facility licensed or permitted  under  the
23    Nursing  Home  Care  Act,  the Life Care Facility Act, or the
24    Community Living  Facilities  Licensing  Act,  or  subsection
25    (a-20)  of Section 30 of the Alternative Health Care Delivery
26    Act.
27    (Source: P.A. 90-341, eff. 1-1-98.)

28        (Text of Section after amendment by P.A. 91-656)
29        Sec.  10.   Facility  defined.   As  used  in  this  Act,
30    "facility" means a facility licensed or permitted  under  the
31    Nursing  Home  Care  Act,  the  Life  Care  Facility Act, the
32    Assisted Living and Shared  Housing  Act,  or  the  Community
 
                            -12-               LRB9112970JSpc
 1    Living  Facilities  Licensing  Act,  or  subsection (a-20) of
 2    Section 30 of the Alternative Health Care Delivery Act.
 3    (Source: P.A. 90-341, eff. 1-1-98; 91-656, eff. 1-1-01.)

 4        Section 95.  No acceleration or delay.   Where  this  Act
 5    makes changes in a statute that is represented in this Act by
 6    text  that  is not yet or no longer in effect (for example, a
 7    Section represented by multiple versions), the  use  of  that
 8    text  does  not  accelerate or delay the taking effect of (i)
 9    the changes made by this Act or (ii) provisions derived  from
10    any other Public Act.

11        Section  99.  Effective date.  This Act takes effect upon
12    becoming law.

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